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dc.contributor.authorIlse C E Hendriksenen_US
dc.contributor.authorJosefo Ferroen_US
dc.contributor.authorPablo Montoyaen_US
dc.contributor.authorKajal D. Chhaganlalen_US
dc.contributor.authorAmir Senien_US
dc.contributor.authorErmelinda Gomesen_US
dc.contributor.authorKamolrat Silamuten_US
dc.contributor.authorSue J. Leeen_US
dc.contributor.authorMarcelino Lucasen_US
dc.contributor.authorKesinee Chotivanichen_US
dc.contributor.authorCaterina I. Fanelloen_US
dc.contributor.authorNicholas P J Dayen_US
dc.contributor.authorNicholas J. Whiteen_US
dc.contributor.authorLorenz Von Seidleinen_US
dc.contributor.authorArjen M. Dondorpen_US
dc.contributor.otherMahidol Universityen_US
dc.contributor.otherUniversity of Oxforden_US
dc.contributor.otherHospital Central da Beiraen_US
dc.contributor.otherHealth Alliance Internationalen_US
dc.contributor.otherUniversity of Washington, Seattleen_US
dc.contributor.otherMinisterio da Saudeen_US
dc.contributor.otherMenzies School of Health Researchen_US
dc.identifier.citationClinical Infectious Diseases. Vol.55, No.8 (2012), 1144-1153en_US
dc.description.abstractBackground.Severe falciparum malaria with human immunodeficiency virus (HIV) coinfection is common in settings with a high prevalence of both diseases, but there is little information on whether HIV affects the clinical presentation and outcome of severe malaria.Methods.HIV status was assessed prospectively in hospitalized parasitemic adults and children with severe malaria in Beira, Mozambique, as part of a clinical trial comparing parenteral artesunate versus quinine (ISRCTN50258054). Clinical signs, comorbidity, complications, and disease outcome were compared according to HIV status.Results.HIV-1 seroprevalence was 11 (74/655) in children under 15 years and 72 (49/68) in adults with severe malaria. Children with HIV coinfection presented with more severe acidosis, anemia, and respiratory distress, and higher peripheral blood parasitemia and plasma Plasmodium falciparum histidine-rich protein-2 (PfHRP2). During hospitalization, deterioration in coma score, convulsions, respiratory distress, and pneumonia were more common in HIV-coinfected children, and mortality was 26 (19/74) versus 9 (53/581) in uninfected children (P < . 001). In an age-and antimalarial treatment-adjusted logistic regression model, significant, independent predictors for death were renal impairment, acidosis, parasitemia, and plasma PfHRP2 concentration. Conclusions.Severe malaria in HIV-coinfected patients presents with higher parasite burden, more complications, and comorbidity, and carries a higher case fatality rate. Early identification of HIV coinfection is important for the clinical management of severe malaria. © 2012 The Author.en_US
dc.rightsMahidol Universityen_US
dc.titleDiagnosis, clinical presentation, and in-hospital mortality of severe malaria in HIV-coinfected children and adults in mozambiqueen_US
Appears in Collections:Scopus 2011-2015

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